Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

An Assessment of Bleeding Complications Necessitating Blood Transfusion across Inpatient Plastic Surgery Procedures

A Nationwide Analysis Using the National Surgical Quality Improvement Program Database

Thomas, Analise B., M.D.; Shammas, Ronnie L., M.D.; Orr, Jonah, B.S.; Truong, Tracy, M.S.; Kuchibhatla, Maragatha, Ph.D.; Sergesketter, Amanda R., B.S.; Hollenbeck, Scott T., M.D.

Plastic and Reconstructive Surgery: May 2019 - Volume 143 - Issue 5 - p 1109e–1117e
doi: 10.1097/PRS.0000000000005537
Plastic Surgery Focus: Special Topics

Background: This study described the prevalence of bleeding complications necessitating blood transfusion across plastic surgery procedures and identified those procedures that may be associated with higher rates of bleeding.

Methods: The authors retrospectively identified patients who suffered from postoperative bleeding complications from 2010 to 2015 using the National Surgical Quality Improvement Program database. This is defined by the National Surgical Quality Improvement Program as the need for transfusion of at least one unit of packed or whole red blood cells. Patient characteristics were described using summary statistics, and National Surgical Quality Improvement Program and univariate analysis of patient characteristics and bleeding complications was performed.

Results: Overall, 1955 of 95,687 patients experienced bleeding complications. Patients with bleeding complications were more likely to be diagnosed with hypertension, have a longer total operative time, and have a previously diagnosed bleeding disorder. The most common primary plastic surgery procedure associated with bleeding complications was breast reconstruction with a free flap, and breast reconstruction with a pedicled transverse rectus abdominis musculocutaneous flap had the highest rate of bleeding. A return to the operating room was required in 539 patients (27.6 percent) who suffered a postoperative bleeding complication. Patients with a preexisting bleeding disorder [n = 1407 (1.5 percent)] were more likely to be diabetic, have a lower preoperative hematocrit, and have a longer operative time. In addition, these patients were more likely to suffer from other nonbleeding complications (1.29 percent versus 0.35 percent; p < 0.01).

Conclusions: Complex procedures (i.e., free flap breast reconstruction) have a higher prevalence of bleeding requiring a transfusion. Furthermore, patients undergoing combined procedures—specifically, breast oncologic and reconstructive cases—may be at a higher risk for experiencing bleeding-related complications.


Durham, N.C.

From the Division of Plastic and Reconstructive Surgery and the Department of Biostatistics and Bioinformatics, Duke University Medical Center.

Received for publication June 7, 2018; accepted October 11, 2018.

The first two authors contributed equally to this work.

Disclosure:None of the authors has a financial disclosure.

Supplemental digital content is available for this article. Direct URL citations appear in the text; simply type the URL address into any Web browser to access this content. Clickable links to the material are provided in the HTML text of this article on the Journal’s website (

Scott T. Hollenbeck, M.D., Division of Plastic and Reconstructive Surgery, Duke University Medical Center, Box 3945, Durham, N.C. 27710,, Instagram: @dukeplasticsurgery, @ronnieshammas, @analisethomas, @sthbeq, Twitter: @shammas_ronnie

©2019American Society of Plastic Surgeons